Is aged care lost in Australia’s electoral wilderness?

Older People Speak Out calls for clarity on
what Australia’s political parties have
planned for aged care service delivery

As Kevin Rudd and Tony Abbott crisscross the country ahead of the federal election, older Australians and those who care for them are increasingly perplexed about why these political leaders are ignoring their concerns.

An important forum held in Brisbane on Thursday night (August 22) saw consumers, carers, industry providers, government representatives and seniors groups raise serious concerns about the direction of aged care policy as well as its implementation.

With scant discussion of ageing or aged care issues during the current electoral campaign, advocacy group Older People Speak Out convened the meeting to solicit issues and potential solutions for consideration by the nation’s political leaders.

OPSO vice-president Tony Townsend, who chaired the meeting, said the momentum for the forum grew out of a frustration with all political parties that – while supporting moves towards a system of consumer-directed care provision – have released very little detail about the practical implementation of such policy.

the momentum for the forum grew out of a frustration with all political parties that – while supporting moves towards a system of consumer-directed care provision – have released very little detail about the practical implementation of such policy.

Many who attended the forum expressed irritation with the current situation, saying tricky provisions and unwarranted complexities confuse and unnecessarily complicate life for consumers, their carers and families as well as service providers and care facilities.

Of most concern were residential care bonds, uncertainty around in-home care packages, growing gaps in essential service provision, the consequences of understaffing as well as underpayment of nursing staff in the residential aged care sector.

“And those things have consumers and their carers rather worried about what’s ahead,” Mr Townsend said.

“Aged Care is in transition with the Living Longer, Living Better legislation coming into being. But there are consumers waiting for care or accessing care right now and their needs are not being met. And they can’t wait for the new system to be ramped up to speed.”

Picture: Len Matthews/Flickr

The forum heard that recent National Seniors research had shown that 47 per cent – or almost 6.9million – of those who will vote in Australia’s September 7 election will be over 50 years of age.

“Many of these voters are carers of others who use or will use aged care or consumers themselves,” Mr Townsend noted.

“Just over 50 per cent of all women will use permanent residential aged care for at least a short period in their lives and just under 50 per cent of men will do so. The rest are continuing to live at home but not all are able to access care packages to help them stay at home.”

Just over 50 per cent of all women will use permanent residential aged care for at least a short period in their lives and just under 50 per cent of men will do so

With almost nothing about aged care mentioned in either of the first two “debates” between Labor Prime Minister Kevin Rudd and Coalition Leader Tony Abbott, those who attended the OPSO forum had several critical questions they want on the national political agenda ahead of the September 7 election.

What is being done to make aged care easier to navigate?

In Australia, an industry representative confirmed, there are around 200,000 people in residential aged care and roughly a further 1 million accessing aged care services. To date there are fewer than 100,000 aged care packages to help older Australians stay at home longer.

The forum heard from providers, carers and those who are likely to need care assistance in future that the process of accessing and delivering care is far too complex for many to adequately fathom the financial implications or policy complexities they face.

In many cases, the forum was told, individuals and families who found a loved one needed residential care had not planned far enough ahead, or they had left arranging residential care until a crisis arose.

Then they would find themselves facing a double whammy: higher bonds and lower levels of pension support because their loved ones’ financial affairs had not been put in order early enough.

“Rushed families can make inappropriate financial decisions that gravely disadvantage their loved ones,” one seniors group representative said.

An aged care provider noted that the time to be thinking about what Centrelink might want or appointing an enduring power of attorney was at least five years and preferably eight or more years before someone needed residential aged care.

Rushed families can make inappropriate financial decisions that gravely disadvantage their loved ones

A seniors advocate agreed: “Five years triggers Centrelink benefits but you need to think about all this well before that. Those without means are protected, but those with means face complex considerations that need professional advice well in advance of their care needs.”

With an increasing number of older Australians being diagnosed with dementia, it was widely acknowledged that even planning that far ahead may still not be early enough to put sensible arrangements in place.

“It can be very difficult, for instance, when people are going into dementia. It may not be picked up by loved ones because the initial effects are concealed,” an aged care provider noted.

And, by the time families realise something is seriously amiss, their loved one may no longer be able to administer their affairs properly.

Picture: SalFalko/Flickr

Why is accessing aged care services so complex and so costly?

The vexed issue of residential care bonds raised several concerns.

Industry representatives explained that many individuals and families are quite shocked by the size of the bonds quoted, most not initially comprehending at least that, when their loved one dies, the bulk of that bond will be returned to their estate.

Often, admitted an aged care facility representative, potential residents and their families also did not seem to know that bonds, while regulated, might be negotiable.

“Some facilities – particularly faith-based organisations – have been allowing room for negotiation on bond amounts, depending on the resident’s circumstances. But few people know this,” the aged care provider admitted.

an industry of brokers has sprung up to help negotiate more reasonable bond amounts. The rub is that it can cost up to $4000 to engage a negotiator with aged care experience

So an industry of brokers has sprung up to help negotiate more reasonable bond amounts. The rub is that it can cost up to $4000 to engage a negotiator with aged care experience.

“Also, some families are often reluctant to sell a family home or unit because the amount of equity isn’t high enough or they expect the sale price to improve given more time,” one seniors advocate noted.

This reluctance would then contribute negatively to their loved one’s overall financial position. And bonds, in many cares, are time-prescriptive.

Recently Leading Aged Services Australia’s General Peter Cosgrove (Retired) said that, increasingly, there are instances where two generations of the same family are in aged care, one in high care and one in low care. However, the distinction between the two levels of care is being removed.

Those at the forum said this raised obvious questions about whether such families could afford multiple bonds and if they be forced to sell their family home to enter into care.

One seniors advocate told of the anguish and stress experienced by one south-east Queensland family, a couple in their 70s who have an elderly parent and an adult disabled child living with them.

The woman, who had herself recently become quite unwell, had been carrying the role of principal carer for her seriously ill partner, their son and the much older parent. In consultation with their doctors, it was decided the couple and the parent needed to go into aged care.

There the battles started. The woman was assessed as needing low care, her partner and the parent high care. Finding a facility that could accommodate them all was tough enough. Then they had to negotiate the supported care needs of the disabled young adult son, who did not belong in an aged care facility. All before they even started to get ready to enter care.

The task, says the advocate, has been overwhelming and extremely stressful for all involved.

How many elderly couples around the nation are in all likelihood caring for elderly parents plus, perhaps, one or more disabled children? All will fret about the welfare of their disabled children after their own deaths.

How many elderly couples around the nation are in all likelihood caring for elderly parents plus, perhaps, one or more disabled children? All will fret about the welfare of their disabled children after their own deaths.

With an ageing population, the issue of consumer-directed care packages – delivering the choice to stay at home and receive care there – is also still mired in uncertainty as the government boosts the number of CDC recipients to take the pressure off residential aged care facilities.

To receive CDC a package requires official confirmation of need via an Aged Care Assessment Team review however, as one attendee noted, that agency is months in arrears in many centres, leaving deserving consumers stuck without adequate care.

Also, under this scheme, aged care consumers will get a bucket of money to be used as needed (if their care needs are assessed as low).

Picture: khrawlings/Flickr

“Some will be able to manage this without too much worry, others will not able to do this because of disability, confusion, insufficient education or a lack of awareness,” a seniors advocate noted.

With high care CDC recipients, approved providers will administer their package – for a fee.

“But who will oversee this?” one seniors advocate asked. “Who will ensure this won’t see people kept in their homes for as long as possible because it is an income stream for the provider?”

And not every provider will offer the same range of services in their packages.

Why are aged care nurses so undervalued and over-stretched?

Those attending the forum, universally, want to see better remuneration and career paths for aged care nursing staff as well as better resident-to-staff ratios and greater training, particularly in complex care areas. All were unsure how promised funding would flow through to the coal face.

“There is inadequate staffing and inadequate training, especially when it comes to dealing with dementia, and this is a real concern with dementia rates rising,” one senior retired nurse said, with others at the forum agreeing.

“Trained nurses handle dementia patients better. But turnover among aged care staff is very high, in large part because they are paid less than acute-care nurses, about 25 per cent less, for doing similar work.

“Yet 90 per cent of acute care patients are elderly. How can you attract people to this career when there is this differential?”

turnover among aged care staff is very high, in large part because they are paid less than acute-care nurses, about 25 per cent less, for doing similar work

It was acknowledged that, to fill the breach, many providers were appointing qualified migrant workers who are very caring and prepared to take lower salaries because they struggle to get work elsewhere.

“But they shouldn’t have to accept a lower salary for the same work. That’s discrimination,” one carer noted.

An aged care facility representative said it was incumbent upon providers to provide a career path for their aged care nurses.

“Many years ago we instituted an exchange between aged care and acute care nurses to lift awareness of each other’s roles,” he said. “These sorts of programs are cost neutral but essential for better communication if patients need to go back into hospital or are returning back to their aged care facility.”

Today, many noted, nurses working in acute care settings would be hesitant to work even for a short period of time in aged care for fear the door back to hospital nursing would shut behind them.

Who is overseeing services to the elderly, especially when they don’t gel?

Those at the forum also raised concerns about recent changes to aged care legislation that will see the removal of the distinction between low care and high care residents in aged care facilities.

“It’s wrong if the care needs of residents are in conflict. It’s not always appropriate to accommodate low-care and high-care residents together,” a community aged care facility representative noted.

There are problems, too, in regional and remote areas where, as many noted, subsidised beds for the disadvantaged are scarce or non-existent.

One ethnic communities representative also pointed out an unfair anomaly that faces ageing migrants, and others who have no other family here and who are assessed as needing residential care.

“People without any family (in this country) who need to go into low care can no longer get HACC-assisted transport to attend medical appointments.

“And, in many cases, their care facility will not have the staff to accompany low-care patients, who are mostly left to find their own way,” she said.

“I know of one woman with early stage dementia who was sent in a taxi to a three-hour cognitive assessment but they called me to come pick her up after just one hour because she was in no fit state to complete the assessment and (the assessment team) were concerned for her welfare returning to the care facility.”

Picture: byronv2/Flickr

The recent introduction of the National Disability Insurance Scheme (NDIS), too, presents concerns both for potential recipients, who are still largely uncertain about what happens after they turn 65 years of age, as well as for those who are carers, say, for a disabled adult child who may one day reach 65. This will most likely happen after the parents are deceased.

While it was reassuring to hear that those who already qualified for NDIS support before they turn 65 will continue under than scheme as they enter old age, there will be no insurance packages for those whose disability becomes evident after that age. That, the forum agreed, was unfairly discriminatory.

It also appears as if transport is falling through the cracks in the current system because of “insane”, disparate regulation.

“For example, those who have Extended Aged Care at Home (EACH) or Continence Aids Payment Scheme (CAPS) packages – as well as those already in low care residential care – find they cannot access community transport,” one seniors advocate noted.

“Providers need to negotiate with other providers to round out services in the packages but they are not doing it. Brokering needs to happen between service providers and the process needs to be simplified.

“On the Gold Coast we see very little evidence that service providers are prepared to negotiate with each other to close this gap.”

Providers need to negotiate with other providers to round out services in the packages but they are not doing it

Another seniors advocate noted that, in the past, Queensland Health Metro North declined to fund $5 gocards to be dispensed to elderly patients returning home.

“It’s clear a taxi subsidy needs to be granted to treatment centres or aged care facilities to cater for independent or low-care patients,” she said.

On the other hand, another advocate suggested, a centralised HACC transport database was needed to manage incoming requests for transport to prevent double-booking, “which is more common than you’d expect”.

“On the Gold Coast, demand for community transport is so high that you have to book four days ahead,” she said.

“We have concerns about such inefficiencies and other practices, for example, providers are required to collect a whole lot of personal data about those they would transport, far beyond what they would need. In fact, the amount of private data they have to gather is intrusive. This could be simplified.”

So what needs to be done about aged care right now?

A forum attendee summed up the issues by saying that, despite the extensive array of regulatory requirements put in place to protect those in residential or receiving in-home aged care – an enormous amount of paperwork that “bogs down providers and their personnel” – that framework was not delivering, in practice, the level of care required. In some instances, it was working against such an outcome.

All agreed that this was largely due to a lack of co-ordination, overlaps and inefficiencies in service delivery, plus unforeseen or unaddressed gaps between services.

OPSO’s Mr Townsend pinned down the sentiment of the forum: “We are all individuals and all deserve to be treated as individuals and with respect and dignity. One of the problems with the way aged care is playing out is that seniors are being treated as a number.”

And OPSO’s president, Val French, after observing the 90-minute forum, reminded participants: “Quality of life needs to be ensured for older Australians. This needs to underpin all the decisions going forward. The need to be needed should never be forgotten in all of this. Older Australians need a reason to get out of bed.”

Picture: tbn97/Flickr

Mr Townsend agreed: “There are green shoots in some areas but there’s still a heck of a long way to go with things like age discrimination and aged care.

“What do our political leaders plan to do about these important questions?

“What will be the best choice for the 47 per cent of voters most concerned with the answers? Only party leaders can give these voters the reassurance that is overdue.”

^ The names of most forum participants were withheld to allow them to speak freely and to protect the identities of those in their care.

* Trina McLellan is a freelance reporter who has previously volunteered from time to time with OPSO. She received no payment for this feature. You can see more of Trina’s work at www.reporting4work.com.au and see OPSO’s latest forum tweets at @opsomedia